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E & Q Insurance <br />DECLARATIONS <br />GREAT tHERIC►41Y. REAL ESTATE APPRAISERS <br />INSURANCE GROUP ERRO RS& OMISSIONS IMS URANCE POLICE' <br />3/I E isuHi <br />WPO. I'lodmutl011 4s2101 <br />THIS IS 130111A ['1,,11115 MADE AND RFPUR' D IE SLRANCE MACY. <br />141Is1111.1[ %PPLIF:ti 101M^F(LAIMSl•HAI 4kF F1ksI M%Mo.. WAINti'-M.Iti+URLai <br />A'%4)kEP0MIM)I7%4ARfI1'%G f0THEC0%IPLNi 111 HINT. 1lit: P01.10'PER101). <br />Insumm-crs affov d by dte company imlicawl bx'i,Iu- I CapiLit ucwk ciwr mm-jewrI <br />IE (iMI American Axs,uaace C Ompmnr <br />Nck' the Intiutumv i umllyhy xekctcd whoa Shell h tem hw ivimud ro an the ( 4mpalll <br />Policy Numbw 1-40dG6988-211 kcncunl,-r FI hF'36M1t:ktll•I{7 <br />lln,p un AdannMramor Iferherl FL LJmdy lmamw Agency Inc. <br />loll kl•reWdltr Itrixr, %ilt 301 Narwoad. Wk U1163 <br />Ii; ni i %armd Inrurrd kou FAwad ►4'gldm <br />%ddrm: 251611 Sds I Altk NW <br />Oh, Sr,lr•2tpCodc: Umooksp cks 11ti 55433 <br />hcrn 1, Pnliq Period Flom 1OW3030 Tu I01221'20 -1I <br />(liulh dale 9 12111 dam. Standard TImC aI the m ki cxs ofilk- Named Im.urad ms .%LiLd in ltLat =-1 <br />tI; , a 1 imus of Litrhilil}: <br />i 1 �600,0II1} WmaM Lmlil of Liahilil) Cach Claim <br />H % 1 A110,0M ( Uim l:tpcarrss 1. tWt uCLiuNlt" - Euh Claim <br />I t __Ip.RK) 1}ammt!cs Ixml of 1ANiity - Pnhv�, Augur <br />V. 5 2.0110.0 04 (-Faim E ipraKs krmil of Llnhtliry - Poky AggrgzJr: <br />hcrn5. TW wriM, i I miusme of Claim Espenin): <br />A. S 11.04 Fxh Clsim <br />B. 5 4A4 Awrg- <br />Item 6, Prmidm S 744.94 <br />Ilan'. kedaorr¢iisr Ilam iif gspliabk: I9i'23m15 <br />11cm 9. Form•. NEelrt+ mad FadarwmM% stlsehrrl <br />0421011l011Si 1]4i!.UM NIN 10.111.51 IIt1.424(0101Z1 <br />042402 1011131 04 413 1 004) [11241310&17] D42414 iW19) <br />Rmlhanr;d Reprr.cnt1I1;e <br />A42101 IMP <br />Fm SCIIQ-'T0TAI'appraiW9Aware by a Ja mode, ne. • F -W ALh11DDE <br />P41Wk„r1 <br />